Thoroughly updated for its Second Edition, Fetal Monitoring Interpretation describes and illustrates the full range of patterns revealed by fetal monitoring and explains their clinical significance. The book uses case studies and high-quality tracings accompanied by detailed teaching diagrams usually found only in anatomical and surgical atlases.

This edition includes twenty new case illustrations with teaching diagrams and five added tracings that present rare and unique patterns. The text incorporates the changes in terminology recommended by the 2008 workshop jointly sponsored by the National Institute of Child Health and Human Development, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. Five new sections have been added:

• Pattern Transitions: Emphasizing the dynamic process of bedside assessment of the fetus, this section focuses on changes occurring over time, influenced by factors such as maternal health, pre-existing fetal health, gestation, and medications/anesthesia.


• Antepartum Monitoring: The first edition focused on intrapartum monitoring. The second edition presents a new section on the unique interpretation in the antepartum setting.


• Patterns Associated with Disease States and Other Conditions: For the first time, a section is included that begins with a maternal or fetal condition or the fetal environment and addresses potential fetal heart rate patterns that might be associated.


• Technology Behind Fetal Monitoring and Adjuncts to Fetal Assessment: This new section reviews adjunctive methods of fetal assessment that might improve on the monitor heart rate data in inconclusive situations.


• Medico-Legal Considerations: This section examines the role of the monitor in predicting or retrospectively assisting with the analysis of adverse neonatal outcomes and the future of the monitor in obstetrics.

Foreword

Preface

Acknowledgments

1.Introduction to the Fetal Monitor

• Role of the Electronic Fetal Monitor/Classification/Terminology/
  Basic Review/National Institute of Child Health and Human Development Guidelines/Clinical Application/
  Assessing Uterine Activity/Predicting the Oxygenated Fetus/Identifying the Oxygenated Compensated Fetus/Guiding Delivery Timing of the Fetus with
  Progressive Stress Despite Intervention/
  Recognizing Abnormal Patterns Present from the Outset That Are Compatible with Possible Fetal Jeopardy, Possible Decompensation/Limitations/A Pattern Compatible with A Well-oxygenated Fetus
  in Labor Might Be Followed by a Poor Infant Outcome/A Fetus with a Pattern Associated with Decompensation Might Be Healthy at Birth/Fetuses with Remarkably Similar Fetal Monitoring
  Patterns Might Have Remarkably Different
  Outcomes



2.Basic Pattern Components



• Bradycardia/Tachycardia/Variability/
  Marked Variability: >25 beats per minute/Moderate Variability: 6 to 25 beats per minute/Minimal Variability: ≤5 beats per minute/Absent Variability/Loss of Variability Associated with Sinus Node
  Suppression (as Opposed to Loss of Baseline/Variability/Role of Autocorrelation/Long-versus Short-Term Variability/Periodic and Nonperiodic Changes/Accelerations/Classic/Stimulation/Activity/Periodic Accelerations/Double-Form Accelerations/
  Lambda Pattern/Late Accelerations/Prolonged Accelerations/
  Marked Accelerations/Atypical Accelerations/No Variability in Accelerations Decelerations/Early Decelerations/Late Decelerations/Variable Decelerations/
  Prolonged Decelerations



3. Baseline Variants



• Sinusoidal and Other Undulating Patterns/Sinusoidal Variants/
  Nonsinusoidal Variants/Baseline Shifts and Other Rate Aberrations/Rate Shifts/
  Other Baseline Rate Aberrations



4. Pattern Transitions



• Fetal Stress Dynamic Changes


• Other Pattern Dynamics



5. Uterine/Maternal-Fetal Activity



• Uterine Activity/Classic Contraction Waveform/Decreased Uterine Activity/Dysfunctional Uterine Activity/
  Increased Uterine Activity/Maternal/Fetal Activity/Maternal Fetal



6. Antepartum Monitoring



• Role of the Fetal Monitor in Fetal Welfare Assessment/Nonstress Test/
  Nonstress Test as a Component of the Biophysical Profile/Contraction Stress Test/Other Methods of Fetal Welfare Assessment/Doppler/Fetal Movement Counting/Unique Interpretation in the Outpatient Setting/Baseline/Periodic and Nonperiodic Changes/Contractions



7. Patterns Associated with Disease States and Other Conditions



• Maternal Conditions/Preeclampsia/Eclampsia/Hypertension/Diabetes Mellitus/Respiratory Disease/Maternal Cardiovascular Disease/
  Intrahepatic Cholestasis of Pregnancy/
  Pharmacologic Agents/Exercise/
  Temperature AberrationAnemia/Trauma/
  Advanced Age/Fetal Conditions/Preterm Gestation/Anomalies/Malpresentation/
  Anemia/Infection/Twins/Intrauterine Growth Restriction/Postterm Gestation/
  Support Structures/Umbilical Cord Conditions/Placental Conditions/
  Amniotic Fluid Considerations/
  Uterine Conditions/Second Stage and Delivery/Forceps Effects/Maternal Pushing Effects/Head Rotation Effects/
  Descent Effects



8. Dysrhythmias



• Sinus Node Variants/Sinus Bradycardia/Sinus Tachycardia/
  Sinus Arrhythmia/Sinus Arrhythmia Marked/Respiratory Sinus Arrhythmia Marked with Premature Supraventricular
  Depolarizations/Sinus Pause with Junctional Escape/Sinus Arrest with Junctional Escape/Wandering Atrial Pacemaker/Long QT Syndrome/Dysrhythmias/
  Tachyarrhythmias/Bradyarrhythmias/
  Irregular Rates Produced by Premature
  Depolarizations



9. Technology Behind Fetal Monitoring and
Adjuncts to Fetal Assessment



• External Fetal Monitor Signal Processing 434 Artifacts


• Abbreviated Table of Contents